Teoh Khim H, Huryn Joseph M, Patel Snehal, Halpern Jerry, Tunick Steve, Wong Hwee B, Zlotolow Ian M
Maxillofacial Prosthetics, Dental Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Int J Oral Maxillofac Implants. 2005 Sep-Oct;20(5):738-46.
This study aimed to estimate the cumulative survival rates (CSRs) of implants placed in reconstructed mandibles and to identify prognostic factors that may influence implant survival.
The charts of 24 patients (10 male, 14 female) who had undergone mandibular resection and reconstruction with fibula free-flaps treated with implant-supported prostheses from April 1986 through December 2001 were reviewed. Information on demographics, surgical characteristics, treatment modalities, dentition, implant parameters, prostheses, and hyperbaric oxygen therapy (HBO) was gathered. Kaplan-Meier survival estimates were generated for the 100 implants that satisfied the inclusion criteria. Multivariate Cox proportional hazards regression models accounting for correlated implants within subjects were developed to identify prognostic factors for implant survival.
Ninteen implants had been placed in native mandible (3 in irradiated bone) and 81 in fibula bone flap. Six implants failed during the follow-up period (mean 51.7 months). The overall 5- and 10-year CSRs were 97.0% and 79.9%, respectively. In the univariate analysis, variables associated with implant survival were age, gender, chemotherapy, radiation therapy, HBO, irradiated bone, implant diameter, xerostomia, trismus, opposing dentition, and type of prosthesis. At 5 years, the CSR of implants in patients with HBO was 86.7%; HBO was statistically associated with an increased risk for implant failure (P = .005, hazard ratio = 19.79, 95% CI: 2.42 to 161.71).
The CSR was lower when implants were placed in a previously irradiated mandible. There is still a lack of reliable clinical evidence to support the effectiveness of HBO in these patients.
A high survival rate was demonstrated for implants placed in fibula free-flap reconstructed mandibles. The finding that HBO was a risk factor can probably be attributed to the small sample size; further study is needed in this patient population.
本研究旨在评估植入重建下颌骨的种植体的累积生存率（CSR），并确定可能影响种植体存活的预后因素。
回顾了1986年4月至2001年12月期间接受下颌骨切除并用游离腓骨瓣重建且接受种植体支持修复治疗的24例患者（10例男性，14例女性）的病历。收集了有关人口统计学、手术特征、治疗方式、牙列、种植体参数、修复体和高压氧治疗（HBO）的信息。对符合纳入标准的100枚种植体进行了Kaplan-Meier生存估计。建立了考虑受试者内相关种植体的多变量Cox比例风险回归模型，以确定种植体存活的预后因素。
19枚种植体植入天然下颌骨（3枚植入放疗后骨），81枚植入腓骨瓣。6枚种植体在随访期间失败（平均51.7个月）。总体5年和10年CSR分别为97.0%和79.9%。在单变量分析中，与种植体存活相关的变量有年龄、性别、化疗、放疗、HBO、放疗后骨、种植体直径、口干、牙关紧闭、对颌牙列和修复体类型。5年时，接受HBO治疗患者种植体的CSR为86.7%；HBO与种植体失败风险增加在统计学上相关（P = 0.005，风险比 = 19.79，95% CI：2.42至161.71）。
当种植体植入先前接受过放疗下颌骨时，CSR较低。目前仍缺乏可靠的临床证据支持HBO对这些患者的有效性。
植入游离腓骨瓣重建下颌骨的种植体显示出较高的存活率。HBO是一个风险因素这一发现可能归因于样本量小；该患者群体需要进一步研究。
